Healthcare Provider Details

I. General information

NPI: 1689826075
Provider Name (Legal Business Name): MICHELLE LYNN MIODUSZEWSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W 11TH ST STE 106
ERIE PA
16501-1758
US

IV. Provider business mailing address

240 W 11TH ST STE 106
ERIE PA
16501-1758
US

V. Phone/Fax

Practice location:
  • Phone: 814-464-0627
  • Fax: 814-464-0629
Mailing address:
  • Phone: 814-464-0627
  • Fax: 814-464-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC006865L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOC006865L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOC006865L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOC006865L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOC006865L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOC006865L
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOC006865L
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOC006865L
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC006865L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: